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目的建立预测子宫内膜非典型增生(endometrial atypical hyperplasia,EAH)风险的列线图,个体化评估EAH的发病风险。方法回顾性分析2009年1月至2012年12月在首都医科大学附属北京妇产医院因EAH或CIN3(子宫内膜正常)行全子宫切除术患者的临床资料。以绝经状态分层,统计分析各组患者的临床特征,建立EAH风险预测列线图。结果体重指数(body mass index,BMI)、异常子宫出血(abnormal uterine bleeding,AUB)、超声下子宫内膜厚度(endometrial diameter,E-DIA)为EAH发病的独立风险因素。绝经前患者其OR值分别为1.26(P=0.01)、9.19(P=0.00)、9.72(P=0.00);绝经后分别1.34(P=0.01)、5.80(P=0.03)、61.9(P=0.00)。使用EAH发病的风险因素建立该病风险预测列线图,绝经前后列线图模型符合度分别为78.8%和82.7%。结论 BMI,AUB,E-DIA与EAH发病相关,但对于不同绝经状态的患者,其影响程度不尽相同。EAH风险预测列线图的模型符合度较高,可以用于个体化评估患者发生EAH的风险。
Objective To establish a nomogram to predict the risk of endometrial atypical hyperplasia (EAH) and evaluate the risk of EAH individually. Methods The clinical data of patients undergoing total hysterectomy for EAH or CIN3 (normal endometrium) at Beijing Maternity Hospital affiliated to Capital Medical University from January 2009 to December 2012 were retrospectively analyzed. Stratified by menopause, the clinical characteristics of patients in each group were statistically analyzed, and the baseline of EAH risk prediction was established. Results Body mass index (BMI), abnormal uterine bleeding (AUB) and endometrial diameter (E-DIA) were independent risk factors for the pathogenesis of EAH. The pre-menopausal patients had OR of 1.26 (P = 0.01), 9.19 (P = 0.00), 9.72 (P = 0.00) and 1.34 (P = 0.01), 5.80 (P = 0.03) and 61.9 (P = 0.00). Risk factors for the pathogenesis of EAH were used to establish the risk prediction nomogram of the disease. The compliance of the nomogram model before and after menopause was 78.8% and 82.7% respectively. Conclusions BMI, AUB and E-DIA are related to the pathogenesis of EAH, but their effects are different for patients with different menopause status. The model of the EAH risk prediction nomogram has a high degree of agreement and can be used to assess the risk of EAH in a patient individually.